Macular hole

What is a Macular Hole?

A macular hole is a small tear in the macula. The macula is the central part of the eye’s retina and it is responsible for the sharp, central vision we use for “straight-ahead” activities such as driving, reading and recognising people’s faces. The majority of macular holes enlarge slowly over time causing a person’s central vision to deteriorate, while their peripheral vision remains normal. Macular holes do not indicate or increase the risk of macular degeneration.

What are the symptoms of a Macular Hole?

Early stages of Vitreomacular traction and macular holes may not exhibit any symptoms. Most holes progress over weeks to months to form a full-thickness defect and loss of central vision in the affected eye. During this time, symptoms may include:

Distorted vision (straight lines appear wavy)

Difficulty reading

Increasing blur of printed words

Black or grey spot in the central vision of one eye

Difficulty recognising faces

How are Macular holes detected?

Eye Examination Dilating eye drops are used to enlarge the pupil and then using a slit lamp microscope, the retina and macula are viewed in detail. These drops will blur your vision for 2-3 hours and it is highly recommended that you do not drive on the day of your eye exam.

Optical Coherence Tomography (OCT) is a non-invasive imaging test which uses light waves to detect areas of macular thickening or thinning. This screening can confirm whether Vitreomacular traction or macular hole is present. It is also helpful in monitoring the macula after surgery is performed.

Fluorescein Angiography During this medical procedure a fluorescein dye (vegetable based) is injected into a vein in the arm, the dye then travels through the circulatory system to the blood vessels in the eye. From here a series of photographs are taken as the dye passes through the blood vessels in the retina. Fluorescein angiography can also be used to rule out other possible retinal conditions similar to macular holes.

What treatments are available for Macular Holes?

The current treatment for macular holes is a surgical procedure called a Vitrectomy and Macular Hole Repair. Vitrectomy surgery is performed under local anaesthetic by a retinal specialist in order to close a macular hole. This is done by removing the vitreous jelly from the eye to stop it from pulling on the macula. From here a gas bubble is inserted into the space once filled by the vitreous to assist with sealing the macular hole and provide support. The eye will then naturally refill with the vitreous fluid and the wound self-seals, reducing the need for sutures. To ensure correct placement of the gas bubble, you will be required to lay face down for 50 minutes - after the surgical procedure. The gas bubble will be absorbed by the eye in approximately 7-10 days and as the air is absorbed your vision will begin to return, however, the process of restoring vision occurs over 6-12 months.

For best results, the Eye Specialist Institute recommends this surgery be performed within 6 to 12 months of the macular hole developing/diagnosis. In these cases, 90-95% of macular holes are closed successfully, with 85-90% of patients gaining an improvement in their vision. Typically, the more lines of vision that are lost prior to the surgery are harder to regain after recovery and as a result, patients with longstanding macular holes generally have a lower closure and vision recovery success rate.

What can I expect after Macular Hole surgery?

After a vitrectomy procedure, your vision is usually limited during the first two to six weeks as the gas bubble alters the focus of your eye, making images appear out of focus. The bubble will naturally be absorbed and your vision will gradually return to normal, with complete vision improvement occurring in about 6 to 18 months’ time.The patient typically feels no pain following vitrectomy surgery, however, you may experience some temporary, mild-to-moderate redness and grittiness in the eye, as well as a swelling and drooping of the eyelid.

It is important to note that if you have not had cataract surgery prior to this, a vitrectomy will increase the growth of any cataracts and earlier surgical removal of these will be required.You should also be made aware that having a gas bubble in your eye will mean that you cannot fly for 2-8 weeks following surgery to repair a Macular hole. Your Ophthalmologist at the Eye Specialist Institute will need to check that the bubble has completely dispersed before it is safe for you to fly again. Similarly, the use of anaesthetics containing nitrous oxide (laughing gas) must be avoided while the gas bubble is still present in your eye. You will be given a wristband by your doctor to wear after surgery to notify all medical practitioners that you have gas in your eye.

It is safe for you to resume light physical activity after you have completed the necessary period of positioning which is dependant on the doctor's recommendation specific to your procedure. After a period of 2 weeks you can also take up moderate physical activity, however, strenuous physical exertion should be suspended for at least 6-8 weeks to allow full recovery. You may shower and bathe as usual taking extra caution to avoid getting water in the eye during the first 2 weeks after the surgery.